TM1
Tracking Influenza Vaccine Doses Administered: Pilot Test of CDC’s Countermeasure and Response
Administration SystemPHIN Conference Atlanta, GA
August 26, 2008
Jeanne Santoli, MD, MPH1 and Jeanne Tropper, MS, MPH2
1Immunization Services DivisionNational Center for Infectious and Respiratory Diseases
Centers for Disease Control and Prevention
2Division of Emergency Preparedness and ResponseNational Center for Public Health InformaticsCenters for Disease Control and Prevention
TM2
Co-Authors
• Jeanne Santoli, MD, MPH• Jeanne Tropper, MS, MPH• Tom Shimabukuro, MD, MBA, MPH• Sanjeeb Sapkota, MBBS, MPH• Warren Williams, MPH• Charles Williams, MPH, MA• Ulrica Andujar, MPH• Sabrina Walton, MPH
TM3
Talk Outline
• Background• 2007 Vaccine Doses
Administered Pilot Results; Lessons Learned
• 2008 Vaccine Doses Administered Exercise
• Question and Answer
TM4
Background
• The National Strategy for Pandemic Influenza: Implementation Plan calls for monitoring appropriate use of scarce pre-pandemic/pandemic influenza vaccine
• To accomplish this, Project Areas are expected to track pandemic influenza (PI) vaccine doses administered at the individual patient level and then send a subset of data (minimum data set) on a weekly basis to the CDC; Project Areas are the 50 states, 4 large cities and 8 territories
• CDC’s CRA system has been modified to provide flexible ways for Project Areas to report vaccine doses administered
TM5
PI Vaccine Doses Administered Minimum Data Set for Reporting
to CDC • Project Area ID• Reporting Period Start and End Dates• Vaccine Type (CVX code)• HHS Pandemic Priority Groups
• Homeland and Nations Security• Health Care and Community Support Services• Critical Infrastructure• General Population
• Dose #• Count of Doses Administered per Priority
Group and Dose #
TM7
Countermeasure Response & Administration (CRA) Overview
• Genesis was Pre-Event Vaccination System (PVS) for national smallpox vaccination campaign
• Capability to support mass tracking during an event
• System has been evolved to support any countermeasure, any event
• Includes the ability to track both detail (person level) and aggregate counts of countermeasures
TM8
Pipe-delimited File
State enter data into state’s Immunization Information System or some other equivalent application and is extracted in one of these format.
CRA Option 1 Data exchange
Aggregate data entered directly intoCRA via the web-based aggregate reporting interface
CRA Option 2Direct web entry
The file is then securely transferred to CDC via either CRA application or PHIN MS and loaded into CRA for reporting
Individual level data is entered directly into CRA via the web based flexible Treatment interface
CRA Option 3Individual level data entry
Data is available in CRAfor reporting
Individual level data are automatically aggregated by CRA system and isavailable for reporting
XML File
Aggregate Reporting Options
HL 7
TM9
2007 Aggregate Reporting Pilot Test
• To test the capability to monitor vaccines doses, a pilot using seasonal influenza vaccine as proxy for pandemic was developed
• Pilot Test Purpose:• Project areas on ability to collect and report
to CDC; access aggregate reports • CDC assessed on technical capability of CRA
to accept and aggregate data • Exercise was designed to be minimally
invasive to normal operations• Time frame: November 1 – December 31,
2007• Frequency: Repeatable; at minimum - twice
TM10
Pilot Minimum Data Set
• Project Area ID• Date of Clinics• Age
• 6 – 23 months• 2 – 18 years• 19 – 49 years• 50 – 64 years• 65+ years
TM11
Parameters for Participation in 2007 Pilot
• Identify Point of Contact (POC)• Select option choice• Identify minimum of two clinic
dates• Send data for both clinics within 48
hours – “fully successful”
TM12
Phase I: Pre-Pilot Planning
Apr-Oct 2007
CDC
Tasks
2007 Pilot ActivitiesPhase II: Pilot Test
Nov-Dec 2007
Phase III: Post-Pilot
Jan-Mar 2008 Webinars - Orientation &
introduction
Webinars - Option specific; open Q&A;
Selection of POC
Conference Calls - Individual project areas; follow up for Q&A
PHIN conference presentation
Identify & submit option choices
CRA Development - Version 1.6 release
Pilot Test - Receive & process clinical data from 62 project areas
Finalize & submit clinic dates
Review option-specific checklist
Develop/administer feedback questionnaire
Respond to feedback questionnaire
Develop After Action Report
Conference Call -After Action Review feedback of pilot
Obtain digital certificates
Conduct results briefings
Participate in After Action Review conference call
Submit influenza vaccine doses administered data to CDC
Pilot Test – Project Area support & trouble shooting
PA
Tasks
Apply lessons learned – CRA development, future pilot
TM13
2007 Option Choices by Project Area
Web Entry aggregate
Web Entry Detail
Data Exchange
LA county
DC
NY City
Chicago
Marshall Islands
Guam
Mariana Islands
Virgin Islands
Puerto Rico
Palau
FS Micronesia
American Samoa
TM14
2007 Summary Results• Pre-Planning
• 100% (62/62) identified a POC• 100% (62/62) selected an Option• 85% (53/62) submitted both clinic dates
• Pilot • 89% (55/62) submitted some data • 11% (7/62) did not submit any data• 64% (35/55) fully successful
• Post-Pilot• 55 Respondents completed on-line feedback
questionnaire • 61% (38/62) participated in After Action
Review call
TM15
Kansas Governor, Kathleen Sebelius, getting influenza vaccination in a Pilot Influenza Clinic, Kansas
TM17
Timeliness Among All Options by Aggregation Method
11 11
5
21
6
23
3
0
5
10
15
20
25
30
Data Exchange Web Form Aggregation Individual Pt Data
Num
ber o
f Pro
ject
Are
as Yes (Within 48 hrs)
No( >48 hrs)
Did not report
TM18
Data Submission Timeline All Options
55
24
95
15 16
0
10
20
30
40
50
60
24 hrs 48 hrs 72 hrs 96 hrs >120 hrs Data notreported
Timeline of Data Submission (Hrs)
Nu
mb
er
of
Cli
nic
Da
tes
Note: N= 124 clinic dates
TM19
Aggregation Method Among Web Entry
Aggregate Users (Option 2)
• IIS or other system : 23.5% 8/34• Spreadsheet : 41.2% 14/34• Paper based (reported) : 17.6% 6/34• Paper based (did not report) : 17.6% 6/34
TM20
Timeliness by System Reporting Technique –
Options 1 and 2
21
0
24
10
65 40
63
0
5
10
15
20
25
30
Nu
mb
er
of
Clin
ic D
ate
s
Yes-48 hours
No-48 hours
TM21
Need for More Than Systems!
26 27
4
16
0
5
10
15
20
25
30
35
40
System Manual
Data Aggregation Method
Num
ber
of C
linic
Dat
es
Yes-48 hours
No-48 hours
TM22
Option Choice Switching
5 Project Areas (PA) switched from original option choice to other choice when data reporting began• Option 3 to Option 1: 1 PA• Option 2 to Option 1: 2 PA• Option 3 to Option 2: 1 PA• Option 1 to Option 2: 1 PA
TM23
Feedback Questionnaire
• Project Areas requested to complete anonymous, on-line feedback questionnaire
• Nine questions highlighting:• Efficiency of communication from
CDC• Benefits of pilot test• Issues/barriers encountered• Feedback to improve future
exercises
TM24
Question: How beneficial was this pilot test to you in preparing for a pandemic influenza event in the future?
• 14 respondents : Very Beneficial
• 38 respondents : Somewhat Beneficial
• 3 respondents : Not Beneficial
TM25
Question: What issues, if any, did you encounter while transmitting data to CDC?
• 18 respondents : digital certificate • 12 respondents : file format • 12 respondents : SDN (timing out);
technical issues
• 9 respondents : Coordination with their local health departments
TM26
After Action Review Call Feedback
• Confirmed findings from Feedback Questionnaire• SDN timing out affected efficiency• Digital certificate process was a concern
• Supplemented findings from Feedback Questionnaire• CRA was easy to use• CDC/CRA support was good (technical and project)• Need consistent communication by CDC
• Distribution lists• Requesting all information at once• Leading implementer information
• Support for expanded pilot for 2008 - 2009 influenza season
TM27
Strategies for Addressing Challenges
• Digital certificates: two parallel approaches• System design to allow lower level of
security; expected late FY2009 • Internal decision memorandum of
understanding• Timing-out user sessions: immediate
issue corrected; reviewing configuration to avoid in future
• Communications:• Training conference• Communication consistency• Small group calls
TM28
2007 Pilot Total Doses Administered
• 56,667 doses administered across all project areas
• Doses administered by age group:• 6 – 23 Months: 6.4% (3,618)• 2 – 19 Years: 23.0% (12,999)• 20 – 49 Years: 22.6% (12,836)• 50 – 64 Years : 24.4% (13,847)• 65 Years +: 19.6% (11,119)• Not identified 4.0% (2,248)
TM29
Conclusions• Excellent willingness to participate across
project areas• Vast majority (89%) of Project Areas able to
collect, transmit, retrieve data• Nearly 2/3 of Project Areas submitted data
within 48 hour time period• Challenges do exist, technical issues are
being addressed • CRA able to accept, aggregate data submitted
doses • Issues/barriers identified will assist in
improving Pandemic Influenza preparedness• Project Areas supportive of broader/deeper
testing during 2008 influenza season
TM30
2008 - 2009 Seasonal Influenza Exercise Objectives• Timeframe: October 1 - December 31,
2008• Increase volume: to test system and
operational capacities, Project Areas send data from a minimum of eight clinics during the four weeks
• Track prioritization: to test tracking priority groups, Project Areas use proposed prioritization framework
• Weekly reporting: to test weekly reporting capability, Project Areas send data for a minimum of four consecutive weeks
• Tied to 2009 CDC PHEP continuation guidance biosurveillance requirement
TM31
PHEP Biosurveillance Credit
• PHEP biosurveillance credit• At least one of the eight clinics must be in a
CRI/MSA location• At least one of the eight clinics must be in a non-
CRI/MSA location• For Project Areas residing fully within a CRI/MSA
location (i.e. LA, DC, Chicago, NYC) all eight clinics by default will be CRI-MSA with no non-CRI-MSA clinics reported
• For Project Areas of the Pacific Islands and Territories, Puerto Rico, and the Virgin Islands, which do not have designated CRI-MSA locations, all eight clinics will be non-CRI-MSA with no CRI-MSA reported.
TM32
DAX Status
• Release of CRA v.1.8 development is complete; testing underway
• Exercise planning underway• Vaccine Safety and Doses
Administered Conference concluded 08/22/08
• Project Areas have submitted POCs• Projects Areas are selecting Option
choices
TM33
Acknowledgement• Collaborative effort among:
• National Center for Immunization and Respiratory Diseases (NCIRD) – Immunization Services Division
• National Center for Public Health Informatics (NCPHI) – Division of Emergency Preparedness and Response; CRA Team
• Coordinating Office of Terrorism Preparedness and Emergency Response (COTPER) – Division of State and Local Readiness
• PHEP Grantees and Project Areas – Points of Contact
TM34
"The findings and conclusions in this report are those of the
authors and do not necessarily represent the official positions
of the Centers for Disease Control and Prevention."